右美托咪定和咪达唑仑用于ICU患者镇静效果的系统评价

Efficacy and safety of Dexmedetomidine and Midazolam for sedation in intensive care unit patients: a systematic review

目的比较右美托咪定和咪达唑仑用于重症医学科（ICU）患者镇静的有效性和安全性,为ICU患者合理镇静提供循证依据。方法以右美托咪定或咪达唑仑、ICU、镇静为检索词,计算机检索PubMed、EMbase、Cochrane图书馆、VIP、CNKI、WANFANG数据库,检索时限均为1996年1月1日~2012年3月31日,在按纳入和排除标准进行资料提取和文献质量评价后,采用RevMan 5.0.25软件进行Meta分析。结果纳入10个文献,共计1 633例患者,其中,右美托咪定组900例,咪达唑仑组733例。Meta分析结果显示,①有效性：与咪达唑仑组相比,右美托咪定组机械通气时间较短[WMD=-1.90,95%CI（-1.96,-1.83）,P〈0.01],ICU住院时间较短[WMD=-1.70,95%CI（-1.79,-1.60）,P〈0.01],两组镇静起效时间和停药后苏醒时间差异无统计学意义;②安全性：右美托咪定组谵妄发生率低于咪达唑仑组[RR=0.29,95%CI（0.13,0.62）,P=0.002],两组低血压、心动过缓及需干预的心动过缓发生率的差异无统计学意义。结论右美托咪定用于ICU患者机械通气时间和住院时间较咪唑安定缩短,谵妄的发生率更低,右美托咪定为ICU患者镇静的较好选择。

Objective To review the clinic efficacy and safety of Dexmedetomidine and Midazolam for sedation of the patients in intensive care unit（ICU）.Methods Using the search terms ＂Dexmedetomidine or Midazolam,sedation,ICU＂,trials were collected through searches of PubMed,EMbase,Cochrane Central Register of Controlled Trials（CENTRAL）,VIP,CNKI and WANFANG databases（from January 1,1996 to March 31,2012） for randomized controlled trials about the efficacy and safety of Dexmedetomidine and Midazolam.The included studies were evaluated with criteria and the extracted data were analyzed by RevMan 5.0.25.Results Ten studies involving 1 633 patients met the inclusion criteia.The results of meta-analyses showed that,①efficacy indicator： compared with the Midazolam-treated patients,the Dexmedetomidine-treated patients had shorter the duration of mechanical ventilation [WMD =-1.90,95%CI（-1.96,-1.83）,P 0.01] and shorter the length of ICU stay [WMD =-1.70,95%CI（-1.79,-1.60）,P 0.01],while there were no statistical differences in the onset time of sedation and the awake time;②safety indicator： the prevalence of delirium during treatment was lower in Dexmedetomidine-treated patients [RR = 0.29,95%CI（0.13,0.62）,P = 0.002],while there were no statistical differences in hypotension,incidences of braycardia and braycardia requiring treatment.Conclusion Dexmedetomidine can shorten the duration of mechanical ventilation,the length of ICU stay and reduce the incidences of delirium,which is beneficial for the outcome in ICU patients.